RT Journal Article
SR Electronic
T1 Delayed Incisional Hernia Following Minimally Invasive Trans-Psoas Lumbar Spine Surgery: Report of a Rare Complication and Management
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 5019
DO 10.14444/5019
A1 Gundanna, Mukund
A1 Shah, Kunal
YR 2018
UL https://www.ijssurgery.com/content/early/2018/05/17/5019.abstract
AB Background: Lateral lumbar interbody fusion (LLIF) has proved to be a safe tool in the armamentarium of spine surgeons for a variety of lumbar disorders. However, it has some complications related to specific approaches. Incisional hernia following abdominal surgery and anterior spinal surgery is commonly described; however, it is extremely rare following LLIF, with only 1 case reported in short postoperative period. In this report we present the first case of delayed presentation of true incisional hernia following a LLIF procedure and highlight its presentation, mechanism, possible preventive measures, and management.Methods: We report a 57-year-old lady who underwent L3-4 LLIF. She presented with vague pain in a healed scar area that had no swelling until two years postsurgery, when she developed a painful swelling. On examination, it appeared to be a herniation of abdominal contents.Results: She underwent a laparoscopic hernia repair surgery. The muscular layers were found to be intact with an attenuated transversalis fascia layer. The repair was reinforced by polypropylene mesh. There was no recurrence at the 6-month follow-up.Conclusions: Incisional hernia can occur following LLIF months to years following surgery and can have varied presentation. Tight external oblique closure should be performed because the transversalis fascia often cannot be repaired and the quality of a layered closure of the deep obliques is often disappointing. The treating surgeon should be aware of this complication and aggressively surveil for the warning signs, and patients should be counseled about this potential complication.